Gastric Cancer Screening in Common Variable Immunodeficiency View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2018-10

AUTHORS

David K. van der Poorten, Duncan McLeod, Golo Ahlenstiel, Scott Read, Avelyn Kwok, Cositha Santhakumar, Milan Bassan, Suzanne Culican, David Campbell, Sue W. J. Wong, Louise Evans, Bilel Jideh, Alisa Kane, Constance H. Katelaris, Karuna Keat, Yanna Ko, Jessie A. Lee, Sandhya Limaye, Ming Wei Lin, Ari Murad, Martina Rafferty, Dan Suan, Sanjay Swaminathan, Sean D. Riminton, Catherine Toong, Lucinda J. Berglund

ABSTRACT

Individuals with common variable immunodeficiency (CVID) have an increased risk of gastric cancer, and gastrointestinal lymphoma, yet screening for premalignant gastric lesions is rarely offered routinely to these patients. Proposed screening protocols are not widely accepted and are based on gastric cancer risk factors that are not applicable to all CVID patients. Fifty-two CVID patients were recruited for screening gastroscopy irrespective of symptoms or blood results and were compared to 40 controls presenting for gastroscopy for other clinical indications. Overall, 34% of CVID patients had intestinal metaplasia (IM), atrophic gastritis or moderate to severe non-atrophic gastritis, which can increase the risk of gastric cancer, compared to 7.5% of controls (p < 0.01). Focal nodular lymphoid hyperplasia, a precursor lesion for gastrointestinal lymphoma, was seen in eight CVID patients (16%), one of whom was diagnosed with gastrointestinal lymphoma on the same endoscopy. High-risk gastric pathology was associated with increased time since diagnosis of CVID, smoking, Helicobacter pylori, a low-serum pepsinogen I concentration, and diarrhea, but not pepsinogen I/II ratio, iron studies, vitamin B12 levels or upper gastrointestinal symptoms. There was a lower rate of detection of IM when fewer biopsies were taken, and IM and gastric atrophy were rarely predicted by the endoscopist macroscopically, highlighting the need for standardized biopsy protocols. The prevalence of premalignant gastric lesions in patients with CVID highlights the need for routine gastric screening. We propose a novel gastric screening protocol to detect early premalignant lesions and reduce the risk of gastric cancer and gastric lymphoma in these patients. More... »

PAGES

768-777

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s10875-018-0546-3

DOI

http://dx.doi.org/10.1007/s10875-018-0546-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1107037233

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30219982


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